MEDICARE: PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		FL

General Provider Information

NPI Number	:	1457841017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PA

Provider Business Mailing Address
First Line	:	7050 TAFT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3804
Country	:	US
Telephone Number	:	954-399-9014
Fax Number	:	954-983-1152

Provider Business Practice Location Address
First Line	:	6517 TAFT ST STE 101
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4063
Country	:	US
Telephone Number	:	954-983-9191
Fax Number	:	954-983-1152

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOISES ISSA
Credential	:	MD
Telephone Number	:	954-399-9014

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	12/14/2022

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